I promised Parin that I would address this topic again and explain my point a bit clearer. It all comes down to semantics of the words dependence and addiction. I hope that it is sufficient to say that some medical websites use the words interchangeably, referring to the physiological need for a particular drug. For instance, here is the definition of dependence taken from the e-Medicine Health (a part of WebMD.com) website:

Drug dependence is the body’s physical need, or addiction, to a specific agent. Over the long term, this dependence results in physical harm, behavior problems, and association with people who also abuse drugs. Stopping the use of the drug can result in a specific withdrawal syndrome.

The Mayo Clinic also uses these words interchangeably. I think that for consistency, dependence should refer to physiological need and addiction should add the characteristics of psychological need and drug seeking behaviors.

To answer Parin’s question, no I would not consider someone taking insulin or thyroid medicine addicted or dependent because neither are drugs, but rather replacements for a hormone that is missing.

Getting back to the article. The author’s headline is down-right WRONG on 2 points. First, neither of these drugs (Fiorinal and Percocet) are Migraine drugs. The FDA has not approved their use in the treatment of acute Migraine, although some physicians prescribe them as Migraine rescue drugs.

As I stated in the original post, these medications carry with them a double whammy. Not only can unwary Migraineurs develop medication overuse headaches (MOH), but they also run the risk of becoming dependent on the butalbital in Fiorinal or the oxycodone in Percocet.

RedOrbit’s headline conjures images of Migraineurs sneaking out at night in dark alleys looking for their next fix. This is unfortunate because there is some truth to it. Anyone who takes a medication runs a risk in becoming addicted or dependent. This is NOT the same as abusing the drug. That is a whole other ball of wax.

In the medical community addiction or drug dependence means

is a state in which the body relies on a substance for normal functioning and develops physical dependence, as in drug addiction. When the drug or substance on which someone is dependent is suddenly removed, it will cause withdrawal, a characteristic set of signs and symptoms

It doesn’t mean that the person is liable to engage in dangerous behaviors to get another “fix”. That is drug abuse. Indeed, for most patients on pain medication, the fix is not necessarily just euphoria, but pain relief. And that certainly brings a sense of well-being.

There are many pain relievers that have the potential to cause drug dependence. Two of these are mentioned in the redOrbit article: Fiorial and Percocet. Fiorinal is a combination of three drugs: butalbital, aspirin, and caffeine. Butalbital is a sedative barbiturate that slows down the central nervous system. Patients can become dependent on butalbital and may find themselves taking Fiorinal more frequently just to function.

There is a double whammy in Fiorinal in that the butalbital can cause dependence; the aspirin and the caffeine can cause medication overuse headaches. So the woman highlighted in the article may have had both drug dependence and MOHs.

The same is true for Percocet. It is a similar drug prescribed for pain. It contains oxycodone and acetominephin. Oxycodone is an opoid narcotic pain reliever, similar to morphine. Acetominephin (Tylenol®) is a milder analgesic and enhances the pain relieving properties of oxycodone. Like butalbital, oxycodone can cause drug dependence, especially if taken more frequently than prescribed. The acetominephin can be the culprit in medication overuse headaches.

So it appears that drugs that combine a barbiturate or an opioid analgesic with aspirin, caffeine, or acetominephin carries the risk of both drug dependence (addiction) and medication overuse headaches. It does NOT necessarily lead to drug abuse.

Good News: April 15, 2008 GlaxoSmithKline has received FDA approval for a new drug treatment for acute migraine with and without aura. This “new” drug is a mixed bag. It is called Treximet and is a combination of sumatriptan (Imitrex 85 mg) and 500 mg naproxen sodium. Studies have shown that more migraine sufferers received relief within 2 hours than those who took Imitrex, naproxen sodium, or placebo alone. To view the entire press release go here.

Bad news: I was led to this press release after visiting a Fox news story. The gentleman featured in the article, Richard Higgins, takes over the counter medication for his migraines. These medications inadequately treats his migraine. He can still feel the pain and has tunnel vision among other symptoms. The story went on to state that he knew there “were stronger class of drugs available”, but he was hesitant to take them. Richard stated, “It’s a sedative, Patients can get addicted to this medication. Patients have cognitive and thinking problems.” Now, I can only guess what medication he is referring to, but this is a telling statement because there are classes of drugs developed for migraine treatment that are neither sedatives nor addictive.

First, how many migraine sufferers are under-treated? Second, how many are misinformed about effective treatment for acute migraine. Imitrex has been on the market since 1992 and it really changed my life. But what about Richard and the others who falsely believe that migraine medication is addicting? (Caveat, he may have been referring to a class of drugs that are sedatives and are addicting, but most doctors don’t consider these medications as the treatment of choice.)

My first reaction is shame on primary care physicians who are uninformed about migraine and, therefore, are dispensing misleading information. My second reaction is shame on American culture that demands that men and women have a stiff upper lip, suck it up, and go on with life. It seems that these days pain is a non-issue. With news stories about the addictive potential of some pain relievers, some sufferers are afraid to take anything stronger than aspirin.

My next reaction is shame on the reporter who apparently is no better informed on migraine than Richard and on the editor who printed the article without correcting the error.

I guess these days I shouldn’t be shocked at what I read in the media, but I am saddened that a misinformed migraineur was used as a hook to promote a “new” drug that is made from an old drug that could have treated his pain.